Professor Janice Rymer, Consultant Gynaecologist, Guy's Hospital in London

AUTHORS:  Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov 

In this series the Medspire team interviews doctors about their career, their specialty, the choices they have made and their advice for doctors and medical students. 

Here the subject is Professor Janice Rymer, the national specialty advisor for gynaecology for NHS England and Improvement. She has also held many senior leadership roles within the Royal College of Obstetricians and Gynaecologists, and King's College London Medical School.

A podcast of this interview is available here:

 

How did you get to where you are today?

I trained in New Zealand and after graduation worked briefly in Indonesia. I then went back to New Zealand - I did my specialty training both there, and in the UK. I was also a surgical registrar for a while in New Zealand. 

I never planned to stay in the UK when I came here for my final specialty training, but life's never predictable. I did my higher degree in research at Guy's. I was appointed as a consultant in Auckland, but I delayed this for a year, and then personal life events occurred. Then I was appointed as a consultant at Guy's, as a clinical academic at Guy's and UMDS. So I pulled out of the Auckland post and have been at what is now known as Guy's, Kings and St Thomas' ever since. 

 

What drew you to gynaecology as a specialty?

As a student I thought it was an awful specialty.  Then, while I was doing casualty, I was working with another woman who was doing O&G and just about to sit her part one. I asked her: 'Why on earth are you doing obstetrics and gynaecology?' 

So she went through all the reasons:  obstetrics is very interesting, there's a lot of drama, and there's all of medicine involved in obstetrics and gynaecology. You do a lot of medical stuff, you do a lot of surgery, and most of the time in O&G you're dealing with very young people. I thought: ‘That's really smart, that's a really good idea’. 

Six months later, I sat my part one and then decided to do O&G. It just seemed a sensible thing to do. It's interesting how people have such an influence on you. I was a house FY1 - as it is now - and she was a senior house officer. Our meeting transformed my life as to what specialty I was going to do. And it's a great specialty.

 

What does your role as a national specialty advisor for NHS England and Improvement involve?

I'm the national specialty advisor for gynaecology. It's a very interesting role. I only started last April during the pandemic, so I've never actually met any of my colleagues in person. I'm asked to comment on all aspects of gynaecology, and then I'll suddenly get Parliamentary questions - very controversial topics out of the blue. 

One of my most challenging tasks at the moment is chairing a public oversight group, which deals with all the issues regarding vaginal mesh. This has been very difficult and controversial, and I believe this issue will be ongoing for quite a while. But it's very difficult to resolve,  because there's injured women and there's also women who have been helped a lot with vaginal mesh.

 

Are there any other pressing issues within gynaecology?

The one we're facing now is the COVID recovery programme, so that's going to be catching up on those huge numbers of outpatient appointments and huge waiting lists that we have in gynaecology. 

The other issues that we've got are the postcode lottery for services, for example, assisted conception services. There’s also virginity testing and hymen repairs. These issues are top of the radar at the moment.

 

What are your goals as a national specialty advisor? 

It's really hard to see where gynaecology is going to be in the next 10-to-15 years. Certainly, over the last 10-to-15 years, there's been a huge shift from very interventional surgical options to more medical options, which is a good thing for women because no operation is without risk. 

One of my goals would be to ensure that women make informed consent for their procedures, because then we wouldn't have got into all this trouble over mesh. It's really important that women make informed consent.

Another goal would be to ensure that all post-menopausal women have access to hormone replacement therapy if they want to. I've been heavily involved in female genital mutilation (FGM) patients and I would like to support the eradication of FGM. 

Recently, we've seen abortion being arranged through telemedicine and it would be good to see this carrying on because it's something that could be very positive to come out of COVID. 

The other thing that's going on at the moment, which I hope goes through, is that all women will have access to oral contraception over-the-counter rather than having to get them through prescription. These are major advances for women and will make life easier for them.

 

Can you give more detail about your crucial role in combatting female genital mutilation (FGM)? 

It was during the late 1990s that myself and one of the midwives set up a clinic for survivors - for women who had had FGM. I knew nothing about FGM before I came to the UK, and actually, even a lot of my colleagues in the UK knew nothing about it.  

It was a really interesting clinic to do. It was mainly women who had had FGM and wanted it reversed, either because they were going to have a baby, or because they wanted to integrate into Western society and to have sexual relationships. The clinic became popular by word of mouth more than anything else. We'd see these young girls come to the clinic, have the FGM reversed, sneak out of the clinic, and then a couple of their mates would come along. 

They didn't want anybody else to know. It was their private decision and they certainly didn't want what they were doing to be known about in their community. It was difficult to do follow-ups or any research on these women because they just wanted to come to the clinic, have the FGM reversed and then go away. 

When we first did the clinic, we carried out all of the reversals under general anaesthetic because that's how it was done in London. Then I remember sitting with a colleague one day, and I said: 'Why don't we do this under local anaesthetic?' She thought: ‘I don't know’. Then we talked to a gentleman who said: 'You won't get away with it. They won't let you do it’.  But actually they did let us do it, because it gave them better access, and also, it was two women. 

If it had been a man and a woman, there's no way they would have let us do it under local anaesthetic. This really helped the clinic - it then became a one-stop clinic. The woman would have a consultation, have the reversal and then leave. So when the word got out that's when the clinic did well, because the young women knew they could come in and have it done and nobody would know.  

You felt you were doing a really good thing for these women. And also, during that time they were with us we would talk to them about the practice of FGM and their thoughts on it, and hopefully we would get reinforcement from them that there was no way they would do that to their daughters. 

 

What is the current situation with FGM?

There's definitely still progress to be made because I'm sure it's still happening in this country ‘under the radar’, and that young girls are still being taken to another country to have it done. Unfortunately the pandemic has probably increased the practice of FGM - hopefully not in this country - but in other countries. 

It would be interesting to look at the data once COVID is over and we can see what's been going on. It's an infringement of human rights, so it's a very important topic for everybody.

Until recently you were vice president of the Royal College of Obstetricians and Gynaecologists and you've been a member of the council for 12 years.  What are your proudest achievements at the College?

Being vice president was a fabulous role. My portfolio was education, as well as organising the world congresses. I felt privileged to meet wonderful people, both in this country and around the world, who were so dedicated to improving the health of women globally.

My greatest achievement was helping trainees pass the MRCOG and to embark on their careers. I ran a lot of courses nationally and internationally, and was very influential in the development of the exams - which have now moved into the digital era, I'm pleased to say.

Nothing gave me more pleasure than to go to those fancy ceremonies where people receive their membership, and to see one of my previous FY1s, students or registrars receiving their membership - that's a really lovely feeling. 

Then you meet their parents and have a picture taken with them. It was nice to know that I had been influential in their careers, both in my clinical work at Guy's and Thomas' but also through the College. It’s great seeing other people come up and do really well. That's the best bit.

 

What does your work with gynaecology teaching associates (GTA) involve?

The GTA programme was a great programme. It's probably one of the best things I've ever done. It came about because I was published on how difficult it was for students to learn how to do intimate examinations - particularly for male medical students. 

Working with those lay women was an absolute delight. They’re wonderful women who are passionate about their work, and incredibly altruistic, because all they want to do is make it better for women in the future to have intimate examinations. It's interesting talking to people about the GTAs because they think they must be weird women. They're not weird at all. They're just really excellent women. They're also very good teachers. 

That work has been great, and I believe this programme has had a huge effect on the training of thousands of doctors, when you consider how many even go through King's who have also got the GTA programme set up, and other medical schools. It's not only doing intimate examinations technically correctly, it's doing it with the best communication skills, and that's the beauty of having GTAs train medical students rather than someone like me training them. 

It's much better to have women teaching you the best way to do intimate examinations, as long as they've been taught how to do it technically correctly - which clearly we did - and we still have quite strict governance to ensure that that's still going on. 

 

In your experience, what makes a good leader?

A good leader is someone who treats everybody with respect, is honest and includes everyone to ensure that there's a cohesive team. It’s not rocket science really. 

 

How do you get the best out of people?

It’s important to give a lot of positive feedback, to be very honest, and, quite simply, be kind to people. I'll use medical students as an example. If I see a medical student walking into the clinic then I'll introduce myself, and ask: 'Are you here for the session?' Whereas with some people, a medical student will walk in and they'll just treat them like they're nobody. 

But everybody is a human being. So whatever you're doing, just be nice to people. It's so important and it's so easy! Then you will get a good response, people will feel a part of things, and it will all work really well. 

I have a student with me in the operating theatre all day. As soon as they arrive, I say: 'Hello, nice to see you,' - I introduce them to everybody, get them really involved, and talk to them as I’m going through the surgery. Sometimes at the end of the day they'll say to me: 'That was great, thank you so much’. 

All I did was be nice to them. It's not difficult. And then they learn, because they're not feeling stressed, they're just having a nice time because someone's taking a bit of notice of them. All medical students are very bright - we know that. If you give them a bit of encouragement that’s great. 

 

How do you deal with criticism?

First, you can't please all of the people all of the time. Also, being a woman, you're more vulnerable to getting criticism and coping with it. Men are generally more thick-skinned and just brush it off, but women take it much more personally. 

I was very lucky because when I came to the UK and I was a registrar, there was a small group of women, only four of us, who used to get together for dinner every six weeks. At that dinner, we were ourselves, talking about anything that was troubling us or anything we'd done wrong. This was a great opportunity to get anything off our chests as we knew we'd get good advice from our chums, and that it was confidential. 

This group has continued - 30 years down the line we're all in very senior positions, and we still meet up every few weeks. Even during COVID, we were still having our Zoom calls. It’s been an incredibly good group. When you do get criticism or something's gone terribly wrong, you can tell the girls all about this, and know you're going to get sympathy. 

Also, they may say: 'Well, you could have perhaps done it this way’, or 'Maybe you could do this’. It’s a comfortable space for us all to share our problems. We've all had different problems in different ways. But it's been a lovely support group throughout all of our careers.

 

What are your proudest achievements?

My proudest achievements have been making a difference to women's lives, whether it be through individual consultations, dealing with acute life-threatening situations, doing successful operations or lecturing nationally and internationally to educate people on women's health topics. 

Just making a difference to an individual's life would be my proudest achievement and that can happen in a big way or a little way. Even if someone just bumps into you in the street and says: 'You did this for me, thank you so much’, it's really lovely and you feel that you've made a difference. That's why it's such a great job. As I say, if you're nice to people and you do your best, then you get a lot of rewards.

 

Have you had any major setbacks?

We all have setbacks, both professionally and personally. When things go wrong,  I retreat for a little while, reflect on it, lick my wounds, and then work out what my next step is going to be. And a support group is very helpful. 

There's always people in a lot worse situation than you. You've always got to remember that. People are in better or worse situations and you just think: ‘“Well, I feel very lucky to have good friends, and a good career’. Awful things happen to everybody, but even worse things can happen to people, so you've just got to be grateful for where you're at.

Medical school teachers have to work as a team but there's cut-throat competition at every level of your specialty. What do you think about this paradox?

It's very difficult. I have been fortunate, because when I was at medical school it wasn't such a competitive environment.  Now, you get rated for the foundation jobs, but I never ever had that pressure. I feel terribly sympathetic for medical students being under that pressure because it does make you think: ‘I've got to do better than that person’. 

Whereas when I was at medical school, we were all in it together. I have to confess, I spent a lot of time playing sports when I was at medical school, so I wasn't one of the top students. My mates who were the top students were good at helping me when I didn't quite understand things. There was a much different atmosphere than there is now. It’s difficult now because there is that interpersonal pressure. 

All I can say is that we're always going to need a lot more doctors, everybody's going to get a job, and every job you get is good. For example, my first house job I was sent to the middle - it was considered the ‘armpit’ - of New Zealand, and I thought: ‘Oh, heavens, why am I going down here?’ It was fantastic, because it was a small hospital, and there were only two foundation doctors. We were allowed to do appendectomies as an FY1. I would never have done that in a teaching hospital.

Wherever you go, you're going to have a great time because medicine is such an interesting career. You've just got to reassure people. Even if you're not rated very highly, you're still going to get a good job wherever you go. Also a lot of people don't shine - and I use myself as one of those examples - as a medical student, but once you get into the clinical work, that's when you may well excel, find your passion and pursue it.

The only time I found it difficult - and I guess you could say competitive - was when I was a surgical registrar. Even though my boss said to me: 'You're really good and you're a very good surgeon’, I could see it was such a male-dominated world that it was going to be an uphill battle to get to the top, and that obstetrics and gynaecology was going to be much easier because being a woman is actually a huge advantage. 

That's the only time I've felt the competition was too hard. But that was a long time ago. It's different now. There's a lot more women in surgery now, so it's much better. At that stage, it was pretty tough. But I do feel sympathetic for the pressure that's on medical students to get those ratings. That's really tough.

 

What advice would you give to your younger self?

I've only got one bit of advice to anybody and that's, don't get married until after the age of 30. I won't expand on that, but it's good advice. Before then, I just don't think you know what you're doing, or where you're going. So don't get married until you're 30 would be my only bit of advice. Otherwise, I've got no regrets. I have a great career, and a great life.

 

What habits have allowed you to excel? 

With the Kiwi culture, we are taught to work incredibly hard, so I think I'm a very hard worker with attention to detail. I'm also absolutely obsessed with punctuality, which as a leader is very important. 

Everybody knows that I will be on time, and for an operating list or a clinic that is so important. If the boss isn't there on time, then everybody gets into bad habits, nobody really cares, and everybody gets lazy. But if they know that you're absolutely obsessed with punctuality, then things work well.

 

How do you deal with stress?

The best way I deal with stress is jogging. I absolutely love it. If I have problems or if I've thought someone's been really horrible to me, then I just go out for a jog. And even if it's only for 30 minutes, I come back calmer, I've worked out a solution, and I'm in a much better place. 

Exercise is my great relief. I love jogging outside. We live just by Tower Bridge so running along the waterfront is just gorgeous. It's an easy way to get rid of stress.

 

What tips would you give to medical students and junior doctors?

Just enjoy yourself. Medical training is a great privilege. The people you work with are great. The patients are great, and actually that's one nice thing about getting older is you get a lot more relaxed with patients and you can have a really good laugh with them.  

For medical students my advice, particularly at the moment, would be to get as much clinical experience as you possibly can.  Make chums with the junior doctors and spend weekends working with them. They'll be very grateful to have your help and you'll learn heaps. I just really worry about the exposure of clinical experience over the last 12 months especially, so get as much clinical experience as you can. 

Evenings and weekends are the best time to get experience.  You work with great people in medicine and it's so interesting. You're never bored doing medicine. All the time, you get cases and you think: ‘God, I've never seen that before, how amazing’. It's just great. It always keeps you interested. There’s never a dull moment.

 

Why is teaching important to you?

Young people educate me all the time. People think I educate them, but I educate them to educate me, because the students and the junior doctors are constantly asking me questions:  'Why do you do this?’ ‘Why do you do that?' I've got to be able to explain, and if I can't, then maybe there's something I don't know and I need to know about it. 

Education is a two-way process and young people have got so much interesting stuff going on in their lives. As you can imagine, if I have any techy problem with my iPad, what do I do? I take it to the medical students and say: 'Will you sort this out?' Within seconds, they'll sort out my iPad for me. 

It's an absolute delight working with younger people, and again, I'm very privileged that someone of my age works with students and junior doctors in their 20s and 30s. It's fantastic. Hopefully they'll keep me young.

 

What's your favourite book?

One of my favourite authors is the American author Douglas Kennedy who wrote a book called The Pursuit of Happiness - not to be confused with the movie of the same name. It's one of my favourite books.

Douglas is a fabulous author - all of his books have got a great twist in them and you just can't put them down. There's another good one called The Dead Heart,  but don't ever read it when you're flying into Australia because it's very scary.

 

Medspire podcasts are produced by Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov, both full-time junior doctors. They aim to inspire the next generation of doctors and scientists by exploring the career journeys of leading clinicians and researchers.